Background Mucormycosis is an angioinvasive fungal infection that progresses rapidly and is associated with high morbidity and mortality despite effective treatment. Delayed diagnosis may result in death. The overall mortality rate is approximately 54%, varying according to accompanying comorbidities and the affected body site, and may reach up to 96% in disseminated infections. Case Presentation A 39-year-old male patient presented to the emergency department with swelling and vision loss in his right eye. He had a known history of type 2 diabetes mellitus for three years and was not taking his medications. One week earlier, he had been diagnosed with sinusitis at the otorhinolaryngology outpatient clinic; however, despite treatment, facial swelling increased. On evaluation in the emergency department, he was assessed as having diabetic ketoacidosis and was admitted to the internal medicine intensive care unit under endocrinology care. Insulin infusion therapy and hydration were initiated. Consultations with ophthalmology and otorhinolaryngology were obtained, and the patient was evaluated as having periorbital cellulitis; antibiotic therapy was started. On the second day of hospitalization, as ketoacidosis persisted and acute phase reactants continued to rise, ecchymosis developed on the right side of the face along with dark necrotic lesions in the oral mucosa. With suspicion of mucormycosis, an otorhinolaryngology consultation was requested. Paranasal computed tomography was performed, and a frozen-section biopsy was obtained from the nasal cavity. While imaging and pathology findings were consistent with mucormycosis, the patient developed cardiac arrest on the third hospital day and was intubated after resuscitation. Surgical intervention was considered but deemed inappropriate due to poor general condition. Following consultation with infectious diseases, intravenous amphotericin B at a dose of 5 mg/kg was initiated. On the fourth hospital day, the patient suffered another cardiac arrest and was declared deceased despite resuscitation efforts. Conclusions This case underscores that delayed recognition of mucormycosis in the setting of diabetic ketoacidosis may result in fatal outcomes despite appropriate antifungal therapy, emphasizing the need for early clinical suspicion and urgent multidisciplinary management. Clinical Message In patients with uncontrolled diabetes presenting with rapidly progressive sinonasal or orbital infections, mucormycosis should be suspected early. Delay in diagnosis and inability to perform surgical debridement may lead to fatal outcomes despite appropriate antifungal therapy.
Kotan et al. (Mon,) studied this question.